NPI | 1760630743 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV LPC1900) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701007378) |
Enumeration Date | 2008-09-03 |
Last Update Date | 2019-05-20 |