| NPI | 1699982124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701005879) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 004537) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2014-11-11 |