| NPI | 1548665409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701005713) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2022-02-24 |