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 |