NPI | 1558017103 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10747) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5155-226) |
Enumeration Date | 2022-02-22 |
Last Update Date | 2023-12-08 |