| NPI | 1194471052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 8946) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 7697) |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2025-04-15 |