| NPI | 1366233785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0704017930) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2025-05-15 |