| 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 |