| NPI | 1134148893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC2214) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: DC PRC13893) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-08-23 |