| NPI | 1205997491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 2632) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |