| NPI | 1912565540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AK 132467) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AK 132467) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2021-07-27 |