| NPI | 1972128189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: DC PRC200001206) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: DC LGPC00650) |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2022-02-22 |