| NPI | 1104987874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 01519) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2025-05-27 |