| NPI | 1447960448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0704017739) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2025-01-30 |