| NPI | 1083192504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 225C00000X Rehabilitation Counselor | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2025-07-08 |