| NPI | 1730847526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 7736-226) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC A17155) |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2025-10-16 |