| NPI | 1063627354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0146941) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: 00056257) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2016-06-15 |