| NPI | 1295024289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2010040887) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2010040887) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2011-06-27 |