| NPI | 1295399848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LCM985) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGM787) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-06-18 |