| NPI | 1942831862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 03842) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 3551) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2021-07-07 |