| NPI | 1376976738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5504-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 1607-226) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2021-08-25 |