| NPI | 1467113126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2026-04-30 |