| NPI | 1366008252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 123540) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 206985) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2026-03-23 |