| NPI | 1205727369 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 15268) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WY 675) |
| Enumeration Date | 2025-07-15 |
| Last Update Date | 2025-10-08 |