| NPI | 1902821549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 8819) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 4707) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-11-28 |