| NPI | 1225739568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2024-07-30 |