| NPI | 1164640496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 4637) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: RI MHC02018) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2026-03-19 |