| NPI | 1922542695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 6930125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 6930-125) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2019-07-28 |