| NPI | 1831680289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 13046) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A13046) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2022-08-19 |