| NPI | 1932381787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0134115) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 2416) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2020-04-29 |