| NPI | 1629863923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 12724) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 12724) |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-04-24 |