NPI | 1023409828 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO CSW.00992869) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 919) |
Enumeration Date | 2015-02-15 |
Last Update Date | 2022-09-22 |