| NPI | 1639536535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA 3566) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2022-09-02 |