| NPI | 1063879682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2025-05-28 |