| NPI | 1548776388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ME LC6841) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME CAC6403) |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2021-02-02 |