| NPI | 1902279177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 12493) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701006375) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2025-11-12 |