| NPI | 1033419189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SD LPC1104) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NCC - 46969) |
| 174400000X Specialist (Licence: CBIST - 6578) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2010-10-22 |