| NPI | 1972150654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 8454-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 4434-226) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2022-03-08 |