| NPI | 1689387615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 9201) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 7795) |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-09-20 |