| NPI | 1588392153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC8018) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC14421) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2022-10-14 |