| NPI | 1972306629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: FL p183315) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-03-28 |