| NPI | 1588925721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AR P2606002) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 11169) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2026-07-02 |