| NPI | 1336779453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 376J00000X Homemaker | |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2025-06-25 |