| NPI | 1194196113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 7729) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 46.002833) |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2019-12-02 |