| NPI | 1215459144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-04-28 |