| NPI | 1326092859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 6449) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY 1001) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2012-03-26 |