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 |