| NPI | 1962737403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2021-04-26 |