| NPI | 1831966167 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225400000X Rehabilitation Practitioner | 
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator | 
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-12-06 | 
| Last Update Date | 2025-06-20 |