| NPI | 1255424107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 5002) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD 2993) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-10-02 |