| NPI | 1013065374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 4186) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO LPC4186) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2019-03-18 |