| 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 |