| NPI | 1073811055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC14164) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701006588) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2016-05-24 |