| NPI | 1164845269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0184251) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: NM 0165461) | |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2017-05-24 |