| NPI | 1720659444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 8245) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0024249) |
| 101YP2500X Counselor, Professional (Licence: ID 8331191) | |
| Enumeration Date | 2021-07-03 |
| Last Update Date | 2026-09-15 |