| NPI | 1306054986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 3808) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 4882) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-03-11 |