| NPI | 1881308773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701013750) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2024-07-16 |