| NPI | 1326395476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3425) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-4963) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2017-10-04 |