| NPI | 1164587481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0122899) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: VT 097.0121746) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2019-01-30 |