| NPI | 1033386297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225800000X Recreation Therapist |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 13281900-3503) |
| 101YP2500X Counselor, Professional (Licence: WA RC00049222) | |
| 373H00000X Day Training/Habilitation Specialist | |
| 101Y00000X Counselor (Licence: UT 13281900-6009) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2025-11-03 |