| NPI | 1316175201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC C007304) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC P005119) |
| 101Y00000X Counselor (Licence: NC 1529) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2012-03-12 |