| NPI | 1023428687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC7995) |
| 101YP2500X Counselor, Professional (Licence: VA 0701008614) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2022-03-03 |