| NPI | 1033609565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: N2708) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: N2708) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2020-02-19 |