| NPI | 1609920420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004334) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701004334) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-11-18 |