| NPI | 1710581301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C7648) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2024-03-13 |