| NPI | 1609146703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 1367-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 1367) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2023-02-09 |