| NPI | 1598163313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC7985) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC15033) |
| 101YP2500X Counselor, Professional (Licence: VA 0701007744) | |
| 101YP2500X Counselor, Professional (Licence: MD LGP5954) | |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2018-11-19 |