| NPI | 1427674290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR C7371) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC0016284) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2024-01-09 |