| NPI | 1033572052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: MD 10018850) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225C00000X Rehabilitation Counselor | |
| 171W00000X Contractor | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2025-10-21 |