| NPI | 1720596646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 6679) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 8595) |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2024-08-23 |