| NPI | 1265821318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017092) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AR P1705299) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2023-02-06 |