NPI | 1902212681 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 74731) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MS 335881) |
225800000X Recreation Therapist (Licence: MS 54965) | |
101YP2500X Counselor, Professional (Licence: MS 1903) | |
Enumeration Date | 2014-07-02 |
Last Update Date | 2015-10-19 |