| NPI | 1285334367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 12180-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 7264-226) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2025-12-08 |