| NPI | 1003212507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2026-08-17 |