| NPI | 1316921471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0132481) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 712) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2012-01-27 |