| NPI | 1336452754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL 10644) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NY 004947) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2015-02-20 |