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 | 2024-04-18 |