| NPI | 1740498922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 0971) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 971) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2021-04-19 |