| NPI | 1306478094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: DC LGPC00664) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MD LGP10135) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2020-07-22 |