| NPI | 1578395778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 23251) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2024-08-15 |
| Last Update Date | 2024-10-15 |