| NPI | 1942492160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701004106) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: VA PPS-0601378) |
| Enumeration Date | 2007-08-11 |
| Last Update Date | 2007-08-11 |