| NPI | 1528643350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2025-06-26 |