| NPI | 1770989030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC14557) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701010549) |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2024-03-13 |