| NPI | 1730672890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 9519) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2025-03-27 |