| NPI | 1366804239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 9931) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 175247) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2024-04-22 |