| NPI | 1861604662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA AII6561214) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA AII6561214) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2025-05-01 |