| NPI | 1770248726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701010951) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701010951.) |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2025-02-04 |