| NPI | 1609099019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701010001) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 2787) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2024-02-06 |