| NPI | 1659869287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MO 2015042593) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OR C5804) |
| 101YP2500X Counselor Professional (Licence: WA LH61090547) | |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2023-07-04 |