| NPI | 1669523015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701003525) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 2158) |
| 101YP2500X Counselor, Professional (Licence: TN 1456) | |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2007-07-08 |