| NPI | 1730756800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 124273) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 224258) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2025-06-17 |