| NPI | 1982199204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 103T00000X Psychologist |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2025-06-03 |