| NPI | 1144387283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC2782) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701004397) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2008-08-29 |