| NPI | 1275272619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IN 88002323A) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CO LPCC.0018420) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2025-06-29 |