| NPI | 1093009714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC1349) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC001900) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2011-05-31 |