| NPI | 1649769084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC10385) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP8595) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2026-02-06 |