| NPI | 1679170724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LCO877) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC14807) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2025-08-08 |