| NPI | 1720378086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201007907) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: VA 0119005075) |
| 225X00000X Occupational Therapist (Licence: MI L1939802) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2018-07-12 |