| NPI | 1699806588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VT 068.0104660) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 714) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2015-06-30 |