| NPI | 1093940017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA #4948) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: LA #4948) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2022-07-21 |