| 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 |