| NPI | 1629832951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: CO 61129) |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2025-04-24 |