| NPI | 1780134932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 12502) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A12502) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2022-01-27 |