| 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 |