| NPI | 1255480281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 5212) |
| Additional Taxonomies | 251S00000X (Licence: NC 5212) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2008-07-08 |