| NPI | 1952450173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701003704) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC363) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2012-10-15 |