| NPI | 1720739824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 10003605) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 20487) |
| 101Y00000X Counselor (Licence: TX 88146) | |
| 101Y00000X Counselor (Licence: SC 10501) | |
| 101Y00000X Counselor (Licence: MI 6401224763) | |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2025-05-12 |