| NPI | 1982433280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XM0800X Occupational Therapist, Mental Health (Licence: MI 6801088396) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2024-07-26 |