| NPI | 1316782089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701013697) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701013697) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2025-01-15 |