| NPI | 1710530639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225800000X Recreation Therapist (Licence: 82138) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 1463) |
| 174H00000X Health Educator | |
| 225400000X Rehabilitation Practitioner (Licence: TX 1463) | |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2024-02-27 |