| NPI | 1285246652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: UT 12307961-6004) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C8327) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2024-12-05 |