| NPI | 1174156616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH20581) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL IMH19315) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2024-03-20 |