| NPI | 1811948730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WI 2564-026) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 103303) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |