| NPI | 1659994622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC12688) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LGP10488) |
| Enumeration Date | 2020-05-25 |
| Last Update Date | 2023-06-23 |