| NPI | 1285114462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 171M00000X Case Manager/Care Coordinator | |
| 373H00000X Day Training/Habilitation Specialist | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2025-12-09 |