| NPI | 1689000515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: PA OP006657) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2022-12-21 |