| NPI | 1851364244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VA 0701003278) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701003278) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2020-04-14 |