| NPI | 1740843382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 3368) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2020-11-03 |