| NPI | 1598131187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SC 7602) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701006249) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2025-04-21 |