| NPI | 1114348729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 003206) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2018-10-02 |