NPI | 1215553722 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4771) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C4772) |
Enumeration Date | 2020-06-20 |
Last Update Date | 2025-07-02 |