| NPI | 1073212916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2025-05-07 |