| NPI | 1750264164 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201014368) | 
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics | 
| Enumeration Date | 2025-07-31 | 
| Last Update Date | 2025-08-29 |