| NPI | 1790588440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 10825) |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-04-24 |