| NPI | 1841528361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 2810) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 2810) |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2026-05-11 |