| NPI | 1518584788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10063-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 4658-226) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2022-11-11 |