| NPI | 1336757814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NV 00836-C) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA A048301217) |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-21 |