| NPI | 1346713351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ME LC7198) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME CAC6718) |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2021-04-22 |