| NPI | 1003152505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC4517) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME XL4067) |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2015-07-29 |