| NPI | 1467006130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA Unlicensed) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2025-06-04 |