| NPI | 1205164290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NV CP0079) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NM 0134851) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2014-01-28 |