| NPI | 1013368547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: TX 14569) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: TX 30786) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2016-06-27 |