| NPI | 1568834794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7712) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2024-08-03 |