| NPI | 1417341694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2015016665) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2022-02-24 |