| NPI | 1871229559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC14125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC200001612) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2023-10-10 |