| NPI | 1538575972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 15700) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 5695) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2020-04-20 |