| NPI | 1023409828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO CSW.00992869) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 919) |
| Enumeration Date | 2015-02-15 |
| Last Update Date | 2026-02-11 |