| NPI | 1679997829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 6278) |
| Additional Taxonomies | 227900000X Respiratory Therapist, Registered (Licence: SC RCP4566) |
| Enumeration Date | 2014-02-08 |
| Last Update Date | 2016-04-25 |