| NPI | 1174257497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701011620) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2023-03-03 |