| NPI | 1407156490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 4205-125) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180.000368) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2010-10-25 |