| NPI | 1548976442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 007553) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 005662) |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2024-07-24 |