| NPI | 1700163391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 222Z00000X Orthotist (Licence: GA 110) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 224L00000X | |
| Enumeration Date | 2011-11-09 |
| Last Update Date | 2020-10-05 |