| NPI | 1245372424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 4871) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2006038837) |
| 101YP2500X Counselor, Professional (Licence: KS 1035) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2012-09-10 |