| NPI | 1184329740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 11388) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 7245-226) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2025-01-08 |