| NPI | 1609479252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701012479) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2024-01-25 |