| NPI | 1750842423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XH1200X Occupational Therapist, Hand (Licence: MN 107826) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 2824-19) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-10-06 |