| NPI | 1376152942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101Y00000X Counselor | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2025-08-11 |