| NPI | 1528794153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 101Y00000X Counselor |
| 172V00000X Community Health Worker | |
| 225400000X Rehabilitation Practitioner | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2025-07-22 |