| NPI | 1336406321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701001224) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: VA 0701001224) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2012-04-16 |