| NPI | 1407528060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2021-10-01 |