| NPI | 1265151989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 2470A2800X Technician, Health Information, Assistant Record Technician |
| 247200000X Technician, Other | |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2025-06-11 |