NPI | 1811555030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LGP7629) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC10233) |
101YP2500X Counselor, Professional (Licence: VA 0701010194) | |
Enumeration Date | 2019-06-03 |
Last Update Date | 2021-06-25 |