| NPI | 1275217408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC14290) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 006081) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2024-04-15 |