| NPI | 1245756782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701007064) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0711000325) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2024-06-18 |