| NPI | 1710423421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006914) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC14770) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2017-01-19 |