| NPI | 1770529521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701005187) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH 3216) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2012-05-22 |