| NPI | 1275145278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0018613) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701013989) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2024-10-28 |