| NPI | 1306588124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC11875) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0701013422) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2025-01-14 |