| NPI | 1336992858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 104100000X Social Worker |
| 374K00000X Religious Nonmedical Practitioner | |
| Enumeration Date | 2024-04-08 |
| Last Update Date | 2024-04-08 |