| NPI | 1942509930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CI1599) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2021-05-12 |