| NPI | 1487883997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH8099) |
| 225400000X Rehabilitation Practitioner | |
| 251B00000X Case Management | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2017-05-02 |