| NPI | 1376259051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701013273) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0704011635) |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2024-02-08 |