| NPI | 1609637123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 10001676) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC002458) |
| Enumeration Date | 2024-01-22 |
| Last Update Date | 2024-04-19 |