| NPI | 1083335285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0704005653) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 18420) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2023-04-24 |