| NPI | 1831689942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017096) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0017096) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2025-04-22 |