| NPI | 1295087559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2009032567) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 1876) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2012-10-11 |