| NPI | 1356561898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004010) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC13837) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2009-06-18 |