| NPI | 1700229010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 0000004036) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701009470) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2026-02-26 |