| NPI | 1154454445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 51295) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 2403) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |