| NPI | 1780026740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701006164) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0014996) |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2025-09-05 |