| NPI | 1124537584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 1843) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 4404) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2022-07-21 |