| NPI | 1801692389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701015295) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0704017352) |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-09-29 |