| NPI | 1114018876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 002707) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 53979) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2025-09-11 |