| NPI | 1013244151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004680) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH17414) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2020-11-17 |