| NPI | 1043864549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA A101170315) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA A01170315) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2019-08-01 |