| NPI | 1487395885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SD LPC20776) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SD LPC20776SUPERVISEE) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2023-05-31 |