| NPI | 1396801957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 385HR2055X Respite Care Respite Care, Mental Illness, Child |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2024-11-15 |