| NPI | 1962891788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701014432) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 251E00000X Home Health | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2025-06-19 |