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 |