| NPI | 1790596054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AL ALC01537) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL ALC05137) |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |