| NPI | 1346907649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2024040008) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 10642-125) |
| 101Y00000X Counselor (Licence: WI 5164-226) | |
| Enumeration Date | 2021-11-21 |
| Last Update Date | 2024-12-16 |