| NPI | 1417030834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO CS002474) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 002474) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2024-05-06 |