| NPI | 1518635473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 2862) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS P-0533) |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2022-09-26 |