| NPI | 1891155792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC5420) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ME XL4658) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2024-01-09 |