| NPI | 1881115590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701007505) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2018-10-24 |