| NPI | 1770134124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC6417) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: GA LPC002191) |
| 101YP2500X Counselor Professional (Licence: DC PRC14213) | |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2019-09-26 |