| NPI | 1154172260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E126011) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA E126011) | |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2025-06-12 |