| NPI | 1386227585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: DC PRC200001781) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MN 2835) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2023-09-21 |