| NPI | 1134785132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2019023424) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2023-07-27 |