| NPI | 1225477854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101Y00000X Counselor |
| 225400000X Rehabilitation Practitioner (Licence: NV 1225477854) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2025-11-10 |