| NPI | 1912657669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 006673) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CT 004610) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-08-17 |