| NPI | 1922140433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NC 1655) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2013-12-31 |