| NPI | 1871007336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C6556) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 6190) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2026-03-03 |