| NPI | 1043773799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: PR 1549) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PR 1549) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2019-04-10 |