| NPI | 1932757416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2020-12-11 |