| NPI | 1528677325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0134358) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068.0134241-EMGY) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2021-07-23 |