| NPI | 1437734050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701011610) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0704013319) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2024-02-19 |