| NPI | 1588229678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 10495) |
| Additional Taxonomies | 374K00000X (Licence: OK 70453) |
| Enumeration Date | 2019-05-05 |
| Last Update Date | 2024-04-22 |