| NPI | 1992256424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017719) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2021-11-03 |