| NPI | 1336542422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 693) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: GA 00116134) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-02 |