| NPI | 1710748728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AL 2912) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 2912) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-01-17 |