| NPI | 1205521945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701014814) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701014814) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-02-21 |