| NPI | 1497013221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: KS 2472) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KS 2309) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2023-03-22 |