| NPI | 1962065649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701008293) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701008293) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2020-02-04 |