| NPI | 1962888081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC6174) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 263696) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2022-10-24 |