| NPI | 1316538531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701012113) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0704011479) |
| Enumeration Date | 2021-01-30 |
| Last Update Date | 2023-02-20 |