| NPI | 1295170611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO 0013027) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0013027) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2016-06-30 |