| NPI | 1346795846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 12403) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A12403) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2020-09-15 |