| NPI | 1447690441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 03669) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2023006572) |
| 101Y00000X Counselor (Licence: FL MH12117) | |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2024-04-15 |