| NPI | 1295788867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO CS002646) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 002646) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-12-14 |