| NPI | 1952918567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XM0800X Occupational Therapist, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2024-08-26 |