| NPI | 1225126857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC#1622) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 1622) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-07-14 |