| NPI | 1841584836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2012-08-23 |