| NPI | 1669512232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2016-07-29 |