| NPI | 1770012825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701009268) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2017017276) |
| 101YM0800X Counselor, Mental Health (Licence: MO 2017017276) | |
| 101YP2500X Counselor, Professional (Licence: MO 2017017276) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2020-12-31 |