| NPI | 1104381797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10680-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 12398) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2026-07-09 |