| NPI | 1740384213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AL 3093) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MS 1229) |
| 101YP2500X Counselor Professional (Licence: NC 12575) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2024-03-22 |