| NPI | 1477923050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701007293) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH13007) |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2022-08-22 |