| NPI | 1588377519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC15214) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP12778) |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2024-06-21 |