| NPI | 1871327072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 3129) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0022092) |
| 101YP2500X Counselor, Professional (Licence: LA TEL1036) | |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2026-01-13 |