| NPI | 1831589456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 11386) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 11386) |
| 101YP2500X Counselor, Professional (Licence: NC 11386) | |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2022-06-02 |