| NPI | 1558017103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10747) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5155-226) |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2023-12-08 |