| NPI | 1326357310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101Y00000X Counselor |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2025-08-26 |