| NPI | 1225649031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701009934) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2026-04-17 |