| NPI | 1043646102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2023-09-14 |