| NPI | 1811658073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2021046587) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2021046587) |
| Enumeration Date | 2022-01-09 |
| Last Update Date | 2025-08-26 |