| NPI | 1821215138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK PCOP739) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 2726) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2026-04-22 |