| NPI | 1174195986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| 372600000X Adult Companion | |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2026-10-29 |