| NPI | 1265642003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 12394) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 2535) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |