| NPI | 1245850130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VT 068.0134227) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 068.0134227) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2023-08-09 |