| NPI | 1376082263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2023048881) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 03764) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2025-07-31 |