| NPI | 1801008479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC5837) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN cc03508) |
| 101YP2500X Counselor, Professional (Licence: CT 5886) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2025-12-16 |