| NPI | 1518230952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CI0181) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2016-08-25 |