| NPI | 1801305701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 003248) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC11991) |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2024-03-25 |