| NPI | 1225442452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 171M00000X Case Manager/Care Coordinator | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2026-02-07 |