| NPI | 1033403878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 0165731) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2015-04-06 |