| NPI | 1821552654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 5117) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC A14547) |
| Enumeration Date | 2019-01-25 |
| Last Update Date | 2022-02-08 |