| NPI | 1295299683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC13829) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP7659) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2023-05-09 |