| NPI | 1821632431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701008862) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC10007) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2023-09-23 |