| NPI | 1851801799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2023024968) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180011737) |
| 101YP2500X Counselor, Professional (Licence: CA 9438) | |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2024-08-05 |