| NPI | 1609500065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: 82632) |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2025-05-22 |