| NPI | 1861120438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| 104100000X Social Worker | |
| 225X00000X Occupational Therapist | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2025-11-01 |