| NPI | 1295996130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 2652) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL C1299A) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2010-04-30 |