| NPI | 1851074769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL LPC05007) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL LPC05007) |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2025-06-02 |