| NPI | 1558075077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 133N00000X Nutritionist |
| 171000000X Military Health Care Provider | |
| 171000000X Military Health Care Provider | |
| 221700000X Art Therapist | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-01-09 |