| NPI | 1922633593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC200001711) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC16641) |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2026-01-22 |