| NPI | 1316257983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701007329) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 10445) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2021-08-24 |