| NPI | 1356577308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC S9371) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 9371) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2021-02-22 |