| NPI | 1629653985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7754) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 7078) |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2021-06-29 |