| NPI | 1457880684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701007411) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-06-10 |
| Last Update Date | 2020-04-01 |