| NPI | 1922375088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2022029311) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 7348) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2024-04-22 |