| NPI | 1063098192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 282577) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 4360) |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2023-02-17 |