| NPI | 1306364369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 101YM0800X) |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2023-04-04 |