| NPI | 1245709708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7626) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 6925) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2023-02-15 |