| NPI | 1568977486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 13574) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NY 7974) |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2026-01-06 |