| NPI | 1801195896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: 15637) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2011-03-16 |