| NPI | 1285690123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO B4883) |
| Additional Taxonomies | 174400000X Specialist |
| 101YP2500X Counselor Professional (Licence: CO 9792) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2009-12-01 |