| NPI | 1114089992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2000166244) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 894) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2007-07-08 |