| NPI | 1033402797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171400000X (Licence: MO $$$$$$$$$) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: CA 10072014) |
| 225800000X Recreation Therapist (Licence: CA 260192) | |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2024-10-02 |