| NPI | 1518683671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0014241) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CO 0014241) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2023-05-23 |