| NPI | 1114488038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 6592) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2019-03-26 |