| NPI | 1700842069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C5436) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 273558-6004) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-10-15 |