| NPI | 1730746884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 23845) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2025-07-29 |