| NPI | 1346505963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701005689) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC prc14196) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2024-09-23 |