| NPI | 1740762848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2017038401) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 2695) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2018-09-05 |