| NPI | 1013202290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR C3957) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OR R2951) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2023-01-19 |