| NPI | 1275682122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| 372600000X Adult Companion | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2025-08-18 |