| NPI | 1982187613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2018030265) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 13033) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2026-01-24 |