| NPI | 1366595142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0006489) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 966) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2018-03-06 |