| NPI | 1972099653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: MI 5201007278) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2023-09-22 |