| NPI | 1639460546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701005525) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 12489) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2024-04-11 |