| NPI | 1346402591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2024-11-05 |