| NPI | 1558040667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: UT 12993710-6009) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2023-07-17 |