| NPI | 1073613782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 13283) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WV 1300) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2026-06-01 |