| NPI | 1689110892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7521) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 3111) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2024-01-17 |