| NPI | 1811677230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC-9873) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID COUI-9711) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2023-10-26 |