| NPI | 1609394428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C6586) |
| 101Y00000X Counselor (Licence: MT 55639) | |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2025-10-10 |