| NPI | 1245826882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 9255) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 7583) |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2023-10-18 |