| NPI | 1104969807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701001683) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701001683) |
| 251S00000X (Licence: VA 0701001683) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2023-11-07 |