NPI | 1518601723 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701011425) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701011425) |
Enumeration Date | 2022-04-25 |
Last Update Date | 2024-04-08 |