| NPI | 1376347567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2025-04-04 |
| Last Update Date | 2026-08-05 |