| NPI | 1861488371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: SD 0063) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 100335) |
| 225X00000X Occupational Therapist (Licence: IA 01344) | |
| 225XH1200X Occupational Therapist Hand | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2007-07-08 |