| NPI | 1356505770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 821) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 7063) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2014-01-13 |