| NPI | 1417203720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2025-09-26 |