| 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 |