| NPI | 1902377641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0118746) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VT 097.0113092) |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2023-09-18 |