| NPI | 1265868194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 125-3970) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3970) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2024-01-12 |