| NPI | 1033169990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6904) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 4282) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2011-09-28 |