| NPI | 1346837614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR R6512) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MG61107120) |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2024-04-12 |