| NPI | 1043383318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701002303) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0812000321) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2013-09-05 |