NPI | 1679170724 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LCO877) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC14807) |
Enumeration Date | 2020-10-01 |
Last Update Date | 2020-10-01 |