| NPI | 1053378323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 1172123) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 484124) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2008-05-22 |