| NPI | 1750016200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ID 8311986) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ND 921-10-1-17-594) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2024-12-06 |