| NPI | 1922737998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.022914) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C10220) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2026-07-09 |