| NPI | 1144916594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701012377) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC200001822) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2024-02-12 |