| NPI | 1003473026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ME LC7576) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME CAC6402) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2021-05-27 |