| NPI | 1255873154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC5133) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME xl3639) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2021-03-19 |