| NPI | 1750946745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701007508) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701007508) |
| 101Y00000X Counselor (Licence: VA 0701007508) | |
| Enumeration Date | 2019-05-05 |
| Last Update Date | 2021-03-03 |