| NPI | 1932960531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2025046851) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 145750) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2026-01-12 |