| NPI | 1285808451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5065) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 4849) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2011-11-01 |