| NPI | 1235792425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SC 6891) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DE 0000845) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-10-11 |