| NPI | 1760047039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 372600000X Adult Companion | |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2026-08-21 |