| NPI | 1689372757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 9177) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-09-15 |