| NPI | 1023132206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 4187) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 1013) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2014-07-16 |