| NPI | 1063824241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0006277) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 6277) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2019-08-08 |