| NPI | 1962750745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201009899) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: MI 5202007580) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2022-07-21 |