| NPI | 1326366113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 633) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 461) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2010-05-04 |