| NPI | 1417960857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701002875) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0718000069) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2010-04-29 |