| NPI | 1831425123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 4576) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL TPMC5097) |
| 101YP2500X Counselor, Professional (Licence: NC 22598) | |
| Enumeration Date | 2009-10-22 |
| Last Update Date | 2026-02-13 |