| NPI | 1629384102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0011683) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: AR A1007077) | |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2024-06-11 |