| NPI | 1316809262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 10893) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 018266) |
| Enumeration Date | 2025-12-01 |
| Last Update Date | 2025-12-01 |