| NPI | 1518372044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CC4717) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ME XL4349) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2020-12-16 |