| NPI | 1093325268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 2734) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC005200) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2023-05-02 |