| NPI | 1679128557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC7729) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC14446) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2020-07-13 |