| NPI | 1336685262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 265305) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2022-08-12 |