| NPI | 1306332986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD lgp8768) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC10626) |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2026-03-24 |