| NPI | 1760069660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2020039217) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC10526) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2021-03-26 |