| NPI | 1720818289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC18345) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP15398) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2026-08-14 |