| NPI | 1740968650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.020596) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL none) | |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2024-09-19 |