| NPI | 1235414095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 7235) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A8889) |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2024-07-25 |