| NPI | 1679272090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701012670) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0704013358) |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2023-11-08 |