| NPI | 1295764751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT MT2330) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC1476) |
| 101YP2500X Counselor, Professional (Licence: PA PC2232) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2014-04-28 |