| NPI | 1063542801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 1063542801) |
| 172V00000X Community Health Worker (Licence: CA 1063542801) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2025-05-11 |