| NPI | 1174112221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701010203) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701010203) |
| 101YP2500X Counselor, Professional (Licence: DC PRC200001198) | |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2022-03-08 |