| NPI | 1780080150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: PR 722) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PR 722) |
| 101YP2500X Counselor, Professional (Licence: PR 722) | |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2024-04-30 |