| NPI | 1154094290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10314-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 5032-226) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2023-03-16 |