| NPI | 1336981141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-08-05 |