| NPI | 1720338627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701005312) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701005312) |
| 101YM0800X Counselor Mental Health | |
| 101YM0800X Counselor Mental Health (Licence: VA 0701005312) | |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2022-12-14 |