| NPI | 1336511559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 2884) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2018-03-30 |