| NPI | 1376082719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 2366) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 6721) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2019-03-19 |