| NPI | 1306430640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ 19511) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NV CP5747-R) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2024-06-18 |