| NPI | 1316709884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 174H00000X Health Educator | |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2025-09-24 |