| NPI | 1447309646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC3449) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP302) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-11-26 |