| NPI | 1023464948 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4910) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2019002608) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2025-03-18 |