| NPI | 1689080178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 10839) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 10839) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2024-07-15 |