| NPI | 1609069459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC2224) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2022-12-21 |