| NPI | 1679395685 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LGP15781) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0022742) |
| 101YP2500X Counselor, Professional (Licence: DC LGPC200001897) | |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2025-01-25 |