| NPI | 1750382073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701002584) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701002584) |
| 101YP2500X Counselor, Professional (Licence: VA 0701002584) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2007-07-08 |