| NPI | 1255528121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101Y00000X Counselor |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2020-05-12 |