| NPI | 1245043199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A20935) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC A20935) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-12-02 |