| NPI | 1730686122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201010195) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: MI 5201010195) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2018-04-11 |