| NPI | 1689314494 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA NA) | 
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator | 
| Enumeration Date | 2022-03-30 | 
| Last Update Date | 2025-05-12 |