| NPI | 1245215458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 1047-125) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 1047) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2021-02-10 |