| NPI | 1639387277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PRC 13874) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701004315) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-08-12 |