| NPI | 1275624793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 277510-6004) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 3443) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2025-01-14 |