| NPI | 1831670405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC11605) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP8560) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2023-03-06 |