| NPI | 1538884747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C10195) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID 8857) |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2025-07-15 |