| NPI | 1689277337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NY 278800584) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2025-07-02 |