| NPI | 1538558341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ME CC4904) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ME XL4306) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2019-08-28 |