| NPI | 1700087624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 5157) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL TPMC5342) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2024-10-21 |