| NPI | 1780389833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR R10469) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 92900) |
| 101Y00000X Counselor (Licence: WA MC61351988) | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2025-01-31 |