| NPI | 1598496135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C7158) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR R5057) |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2022-12-09 |