| NPI | 1184147407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2025-06-13 |