| NPI | 1891028312 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004678) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0012777) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2016-04-06 |