| NPI | 1437407749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A9792) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2018-05-18 |