| NPI | 1710064845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VA 0717000655) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701000664) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-07-08 |