| NPI | 1093947400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701009042) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC12515) |
| 101YP2500X Counselor, Professional (Licence: DC PRC14465) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2023-02-23 |