| NPI | 1114369824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0136691) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM 0136691) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2026-03-09 |