| NPI | 1023696234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701010419) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VA 0704009027) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2021-04-15 |