| NPI | 1245667385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR R2757) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2016-11-10 |