| NPI | 1508571993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 172V00000X Community Health Worker | |
| 373H00000X Day Training/Habilitation Specialist | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2026-03-06 |