| NPI | 1821554965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 225800000X Recreation Therapist |
| 225800000X Recreation Therapist (Licence: CA 83099) | |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2022-11-18 |