| NPI | 1255457529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC.0011825) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701003730) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2014-08-28 |