| NPI | 1356544522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2021-06-10 |