| NPI | 1720111735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004090) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701004099) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-03-11 |