| NPI | 1235810847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WA LH61280842) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC004984) |
| 101YP2500X Counselor Professional (Licence: OH C.1901803) | |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2023-09-17 |