| NPI | 1043560402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0013963) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 0013963) |
| 101Y00000X Counselor | |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2018-03-17 |