| NPI | 1154885887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC10874) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LGP9063) |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2021-03-22 |