| NPI | 1457545824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701005211) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL mh7751) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2013-03-01 |