| NPI | 1558047902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 1299-6-1-23-645) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ND 1299-6-1-23A) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2025-09-04 |