| NPI | 1689371809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.018210) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA lpc014960) |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2025-03-27 |