| NPI | 1164447223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 1496) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA 13052) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-09-02 |