| NPI | 1871379065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 9523) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 46.006759-ASOC) |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2026-03-16 |