| NPI | 1588320550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC13464) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP11242) |
| Enumeration Date | 2021-11-13 |
| Last Update Date | 2023-01-25 |