| NPI | 1174079172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 4632) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0015110) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2022-09-15 |