| NPI | 1396376257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 005290) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 1622) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2022-03-07 |