| NPI | 1790657815 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701015356) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701015356) |
| Enumeration Date | 2025-09-18 |
| Last Update Date | 2025-10-23 |