| NPI | 1275619678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 1045) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 3860) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-08 |