| NPI | 1508731555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701015543) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701015543) |
| Enumeration Date | 2025-10-09 |
| Last Update Date | 2026-01-27 |