| NPI | 1609482561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0016454) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC.0016454) |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2020-10-21 |