| NPI | 1184941940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 8524) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 7369) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2023-09-08 |