| NPI | 1306480272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701012178) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701012178) |
| 101YP2500X Counselor, Professional (Licence: VA 0701012178) | |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2026-04-30 |