| NPI | 1285871822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 2907) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL C1551a) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2016-10-14 |