| NPI | 1952874596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701008070) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH21674) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2024-08-29 |