NPI | 1477562387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225800000X Recreation Therapist (Licence: TX 40746) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 60363) |
Enumeration Date | 2006-08-07 |
Last Update Date | 2009-06-25 |