| NPI | 1194297952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2026-08-03 |