| NPI | 1518633411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2025-05-07 |