| NPI | 1336454412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5011-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 887-226) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2021-09-14 |