| NPI | 1790324408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 225CA2400X Rehabilitation Counselor, Assistive Technology Practitioner |
| Enumeration Date | 2019-12-27 |
| Last Update Date | 2024-01-17 |