| NPI | 1225019524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701002964) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701002964) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2007-07-08 |