| NPI | 1609365816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC10929) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP8564) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2022-07-27 |