| NPI | 1063754182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YP2500X Counselor, Professional (Licence: OK 6107) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2016-05-16 |