| NPI | 1831106160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701003221) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL MH5501) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-09-17 |