| NPI | 1770939563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 225400000X Rehabilitation Practitioner | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2025-12-19 |