| NPI | 1164969309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2247) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC6867) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2017-01-26 |