| NPI | 1013535509 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 4441) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 4441) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-07-10 |