| NPI | 1124330261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC14806) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: MD LC9874) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2020-06-16 |