| NPI | 1811165921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IA 001527) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MN 2080) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2025-11-29 |