| NPI | 1285119420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 003413) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2018-10-02 |