| NPI | 1760005193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: UT 11938592-6004) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2023-08-09 |