NPI | 1154914620 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 6931) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 14587) |
Enumeration Date | 2021-02-16 |
Last Update Date | 2021-02-16 |