| NPI | 1780194084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 13367) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC A13367) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2020-08-07 |