| NPI | 1497308274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701008483) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 0701008483) |
| 101YP2500X Counselor, Professional (Licence: VA 0701008483) | |
| 102L00000X Psychoanalyst (Licence: VA 0701008483) | |
| Enumeration Date | 2019-07-20 |
| Last Update Date | 2019-07-20 |