| NPI | 1992326458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: VA 0701009220) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC012361) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2020-05-06 |