| NPI | 1942895420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC14670) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MD LGP11179) |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2023-12-28 |