| NPI | 1336427632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 14257) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701004483) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2019-12-09 |