| NPI | 1295074516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2068) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 6230) |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2025-11-10 |