| NPI | 1568822765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2015043531) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2020-06-10 |