| NPI | 1457185621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0019264) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID 6281436) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2026-09-25 |