| NPI | 1265418560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 4211) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2014-03-10 |