| NPI | 1164793097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 2346) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 2391) |
| 101YP2500X Counselor, Professional (Licence: FL MH13609) | |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2018-05-10 |