| NPI | 1083775464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AL 1596) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA 17737) |
| 101YP2500X Counselor Professional (Licence: CO 19242) | |
| 101YP2500X Counselor Professional (Licence: KY 283131) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2025-06-19 |