| NPI | 1962164541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPCC.0017752) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2021-10-11 |