| NPI | 1386714269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 003552) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 1408) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-08 |