| NPI | 1245741354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 11890) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NV CP5012) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2024-11-14 |