| NPI | 1457381360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VA 701002010) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701002010) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2009-09-24 |