| NPI | 1023777174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LAC-21469) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LAC-7200T) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2023-01-11 |