NPI | 1699129437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC7136) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701006565) |
Enumeration Date | 2016-04-18 |
Last Update Date | 2016-07-07 |