| NPI | 1316345507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC9905) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP5308) |
| Enumeration Date | 2014-12-20 |
| Last Update Date | 2020-01-01 |