| NPI | 1194379727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 104100000X Social Worker |
| 171M00000X Case Manager/Care Coordinator | |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2025-03-28 |