| NPI | 1477729655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004250) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701004250) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2023-10-24 |