| NPI | 1639208952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2023015136) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-7982) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2023-07-15 |