| NPI | 1912313735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC5866) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YP2500X Counselor, Professional (Licence: MD LGP4220) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2025-06-09 |