| NPI | 1033563382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 7252) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 101Y00000X Counselor | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2021-05-13 |