NPI | 1235711375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC13473) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MD LCA2906) |
Enumeration Date | 2021-04-27 |
Last Update Date | 2023-01-30 |