| NPI | 1871130047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2019036080) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 03012) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2025-06-20 |