| NPI | 1548764582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA xxxxxxxxxxx) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701007627) |
| 101YP2500X Counselor, Professional (Licence: VA 0701007627) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2019-06-11 |