| 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 |