| NPI | 1528735404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 16942) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2026-03-26 |