| NPI | 1942511829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2007034756) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 12775) |
| 101YP2500X Counselor, Professional (Licence: NV CP5154-R) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2026-03-23 |