| NPI | 1366567786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SC 1770CPC) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 4557 CPC SUPERVISOR) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |