| NPI | 1871211854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 3103) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MS 5451) |
| Enumeration Date | 2022-08-16 |
| Last Update Date | 2024-04-30 |