| NPI | 1407022452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2015009154) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2023-07-25 |