| NPI | 1558038976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC14219) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP11828) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2023-09-11 |