| NPI | 1215759063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0734006199) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC P018335) |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2024-10-31 |