| NPI | 1104282169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 4625) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 5625) |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2021-12-15 |