| NPI | 1740499920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6533) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: NC 6533) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2009-08-20 |