| NPI | 1205157278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 5840) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 686) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2015-02-12 |