| NPI | 1932113164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 328) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 39176) |
| 225100000X Physical Therapist (Licence: NH 2170) | |
| 225100000X Physical Therapist (Licence: CA 10510) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-09 |