| NPI | 1336254556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KS 1868) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS TLPC 1020) |
| 101Y00000X Counselor (Licence: CO 4088) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2017-12-04 |