| NPI | 1255588901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OK 4309) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AK 135786) |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2025-03-14 |