| NPI | 1881208056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0022114) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID 7849) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2025-04-08 |