| NPI | 1023563947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0013168) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC.0013168) |
| Enumeration Date | 2016-08-20 |
| Last Update Date | 2020-06-30 |