| NPI | 1851669022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CI0152) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2019-01-24 |