| NPI | 1164541991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C2709) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC-3109) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2015-03-17 |