| NPI | 1871302307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0019585) |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2025-01-28 |