| NPI | 1700156361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 0000003233) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701005318) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2019-03-21 |