| NPI | 1679237861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 13809) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2024-01-08 |