| NPI | 1164206942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0704016137) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC LGPC200001576) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-08-22 |