| NPI | 1184241952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7182) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 7501) |
| Enumeration Date | 2020-06-28 |
| Last Update Date | 2020-06-28 |