| NPI | 1902692882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2022045278) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2025-04-16 |
| Last Update Date | 2025-04-16 |