| NPI | 1669216271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0704017054) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP15528) |
| Enumeration Date | 2024-06-20 |
| Last Update Date | 2024-09-03 |