| NPI | 1073101713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2025-05-05 |