| NPI | 1285702779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 005248) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 005264) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2015-09-14 |