| NPI | 1659534493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 225600000X Dance Therapist | |
| 225700000X Massage Therapist | |
| 225CA2500X Rehabilitation Counselor, Assistive Technology Supplier | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2025-04-07 |