| NPI | 1669928602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NE 12706) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 10965) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2023-04-03 |