| NPI | 1184146086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0016080) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME XL4913) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2022-11-08 |