| NPI | 1144637034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701010493) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2014-07-13 |
| Last Update Date | 2021-05-17 |