| NPI | 1659989556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MT BBH-PCLC-LIC-80365) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-19271) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2025-07-21 |