| NPI | 1972080919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: IA 002407) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 104623) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2018-07-23 |