| NPI | 1063443091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 1631) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 2624-125) |
| 101YP2500X Counselor Professional (Licence: NM 0064381) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-07-21 |