| NPI | 1902663057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SC 9397) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2019047946) |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2024-03-05 |