| NPI | 1114225612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2010006422) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LAC-12181) |
| 101YP2500X Counselor, Professional (Licence: WI 4430-125) | |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2011-03-07 |