| NPI | 1518561828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2544) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC11142) |
| Enumeration Date | 2020-11-27 |
| Last Update Date | 2021-03-01 |