| NPI | 1679228936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 1679228936) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2023-05-03 |