| NPI | 1962087445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2020041662) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0018890) |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2025-09-16 |