| NPI | 1881126456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 12879) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A12879) |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2020-10-21 |