| NPI | 1922644699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2017034992) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: 2017034992) |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2019-11-18 |