| NPI | 1396269676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 3528) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 104179) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2017-07-28 |