| NPI | 1376115576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701011540) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0704011197) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2022-06-27 |