| NPI | 1760523229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-10464) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10386-024) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2025-02-10 |