| NPI | 1245612761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL MH16831) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC008469) |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2022-02-04 |