| NPI | 1679210660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XM0800X Occupational Therapist, Mental Health (Licence: NC A17444) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 17444) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2025-09-05 |