| NPI | 1427734912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC-9607) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC-9607) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2026-03-10 |