| NPI | 1003529983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701013229) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0704014323) |
| Enumeration Date | 2023-01-05 |
| Last Update Date | 2024-01-22 |