| 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 |