| NPI | 1699129437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC7136) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701006565) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2016-07-07 |