| NPI | 1891212338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XM0800X Occupational Therapist, Mental Health (Licence: MD 26343) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2021-06-03 |