| NPI | 1932504198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC0011628) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CO 0011628) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2025-07-10 |