| NPI | 1699813584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701003240) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0710101620 CSAC) |
| 101Y00000X Counselor (Licence: VA 0701003240 LPC) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2019-10-14 |