| NPI | 1821477142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 0017413) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 0017413) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2024-02-13 |