| NPI | 1205952371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: VA 0715005211) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC35) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-11-16 |