| NPI | 1356305007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C1284) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR 1284) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2023-11-02 |