| NPI | 1720546971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0016955) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPCC.0016412) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2023-09-18 |