| NPI | 1609602077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 13626124a) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ND 1362-6-1-24a) |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-12-11 |