| 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 |