NPI | 1013242114 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC4571) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701006171) |
Enumeration Date | 2009-10-07 |
Last Update Date | 2024-07-17 |