| NPI | 1386963494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 7350) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 7350) |
| 101Y00000X Counselor | |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2023-04-10 |