| NPI | 1184080103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5826) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC014414) |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2025-10-15 |