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 |