| NPI | 1093059537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 017771) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 017771) |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2024-09-05 |