| NPI | 1679905970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 10271) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A10271) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2023-01-04 |