| NPI | 1770939563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 171M00000X Case Manager/Care Coordinator | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2026-06-01 |