| NPI | 1033329685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 104013) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0226) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2025-12-05 |