| NPI | 1457019754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701013212) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0704014423) |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2024-01-12 |