| NPI | 1962855643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701008915) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC5865) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2026-03-19 |