| NPI | 1376037333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2025-05-22 |