| NPI | 1356890586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 6862) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC009909) |
| Enumeration Date | 2016-09-29 |
| Last Update Date | 2018-11-16 |