| NPI | 1194894485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C8383) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 003349) |
| 101YP2500X Counselor, Professional (Licence: UT 1396-4079-6004) | |
| 101YP2500X Counselor, Professional (Licence: ID 7888) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2024-10-02 |