| NPI | 1528679024 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225400000X Rehabilitation Practitioner | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-10 | 
| Last Update Date | 2025-06-10 |