| NPI | 1992826150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 174H00000X Health Educator | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2026-08-20 |