| NPI | 1801553631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10483-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5133) |
| Enumeration Date | 2021-11-29 |
| Last Update Date | 2023-06-21 |