| NPI | 1366822702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV C15724) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2026-05-27 |