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 |