| NPI | 1457990210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC0013966) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0013966) |
| Enumeration Date | 2019-12-27 |
| Last Update Date | 2019-12-27 |