| NPI | 1902128432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0110025) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 2536) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2025-03-14 |