| NPI | 1538218144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0004459) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 4459) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2024-02-05 |