| NPI | 1558081349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2026-06-22 |