| NPI | 1093535767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701014201) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0022350) |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2025-11-18 |