| NPI | 1487365276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC16896) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2025-08-21 |