| NPI | 1356069629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0021079) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 0108829) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2025-08-07 |