| NPI | 1457690729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2025-05-21 |